丙泊酚对血液稀释时组织氧代谢的影响

Effects of propofol on oxygen metabolism during acute normovolemic hemodilution

目的 观察丙泊酚对急性等容血液稀释 (ANH)时组织氧代谢的影响。方法 择期手术病人 2 4例 ,随机分为三组 ,每组 8例 :A组为ANH组 ,P4组为ANH +丙泊酚 4mg组 ,P8组为ANH +丙泊酚 8mg组 ,三组病人ANH后Hct降至 2 7 1 %。漂浮导管放置完成后稳定 2 0min(T1 ) ,P4和P8组给予丙泊酚负荷剂量 2mg/kg后 ,分别给与丙泊酚维持剂量 (P4组 :4mg·kg-1 ·h-1 ;P8组 :8mg·kg-1 ·h-1 )。稳定 1 0min后 (T2 ) ,开始进行血液稀释。同时于T1 、T2 、T3 (血液稀释完成后1 5min)分别监测血液动力学指标和混合静脉血氧饱和度 (S vO2 ) ,血乳酸值 (T1 、T3 )。结果 三组病人ANH后均可见心排血量 (CO) ,每搏量 (SV)升高非常显著 ,外周血管阻力 (SVR)和动脉血氧含量(CaO2 )下降非常显著 ,氧供给 ( DO2 )、S vO2 及血乳酸改变不明显 ;P4和P8组SVR下降显著 ,MAP下降非常显著 ,组间比较无差异。结论 本实验剂量范围内 ,丙泊酚与ANH合用时 。

Objective To investigate the effects of propofol on oxygen metabolism during acute normovolemic hemodilution(ANH).Methods Twenty four patients undergoing elective surgery were randomly divided into three groups:ANH group(group A),propofol 4mg group(group P4),and propofol 8mg(group P8).Hct of three groups was reduced to 0 271 ultimately according to the equation of Gross.A Swan Gans catheter was inserted and stabilized for 20min.Anesthesia induction of two propofol groups was started with a bolus of propofol 2mg/kg and followed by maintenance doses(4mg·kg -1 ·h -1 in group P4 and 8mg/kg/h in group P8).Ten min after that,ANH was introduced in three groups.Results Propofol resulted in a significant decrease in both SVR and MAP,but not in CO and SV.A significant increase of CO and SV was observed during ANH in three groups accompanied by a significant decrease of SVR and CaO 2,but there was no significant difference among three groups.There were no significant changes of DaO 2,SO 2 and lactate in three groups during ANH.Conclusion In the dose range of this study,the combination of propofol with ANH does not interfere with tissue oxygenation metabolism. [